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1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431448

RESUMO

Embolised needles causing injury to the right heart and cardiac tamponade has been reported before in intravenous drug users, but to our knowledge, this is the first reported case of a needle migrating via the pulmonary arterial system to cause perforation of the left ventricle. Appropriate utilisation of imaging modalities such as plain X-ray and point-of-care focused cardiac ultrasound can be vital and life-saving in the emergency setting, and the value of gated multidetector CT as a powerful tool for imaging moving structures is highlighted.


Assuntos
Migração de Corpo Estranho/diagnóstico , Traumatismos Cardíacos/diagnóstico , Ventrículos do Coração/lesões , Agulhas/efeitos adversos , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Ponte Cardiopulmonar , Ecocardiografia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Pericardiocentese , Artéria Pulmonar/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento
3.
J Card Surg ; 35(8): 2093-2096, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652566

RESUMO

Balloon rupture is an uncommon complication during balloon-expandable transcatheter aortic valve replacement (TAVR). We describe a balloon rupture and tearing with intraventricular entrapment complicating transapical-TAVR, as well as our bailout retrieval of the failed device.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Falha de Equipamento , Corpos Estranhos/cirurgia , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso de 80 Anos ou mais , Corpos Estranhos/etiologia , Humanos , Doença Iatrogênica
6.
Cardiol Young ; 30(1): 134-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31916528

RESUMO

This report describes a 3-year-old infant with post-operative mediastinitis complicated by a contained rupture of the right ventricle. A contained rupture is recognised as the huge pulsating prominence of the anterior chest wall. CT confirmed blood communication between the right ventricular outflow tract and the cavity surrounded by the pectoral major musculocutaneous flap. This is a significant case in which severe adhesion between the right ventricle and the musculocutaneous flap could maintain her stable haemodynamics with a pulsating prominence.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Dupla Via de Saída do Ventrículo Direito/cirurgia , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Pré-Escolar , Feminino , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Humanos , Mediastinite/microbiologia , Retalho Miocutâneo/transplante , Complicações Pós-Operatórias/cirurgia , Reoperação , Tomografia Computadorizada por Raios X
8.
Am J Forensic Med Pathol ; 41(1): 35-39, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31876539

RESUMO

The potential complications of cardiac surgery with sternotomy include mediastinitis and major bleeding, events that are infrequent but carry high mortality.We report a unique complication of median sternotomy. A 71-year-old man underwent coronary artery bypass grafting complicated by sternal dehiscence on postoperative day 7. One week after discharge, he presented with purulent drainage from the sternal wound bed and was diagnosed as having mediastinitis. Irrigation, debridement, and sternal reconstruction were performed. Two days later, bleeding was observed in the wound, and during surgical exploration, a tear in the right ventricle was discovered, and the patient exsanguinated and died. Autopsy findings included focal adhesions connecting the posterior sternum to the right ventricle wall, as well as microscopic evidence of focally extensive fatty infiltration along the rupture margin of the myocardium.Pertinent aspects of the case are reviewed, with particular attention to the possible microbial etiology of mediastinal infection and most likely mechanisms of injury contributing to the fatal right ventricular rupture.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Ventrículos do Coração/lesões , Mediastinite/etiologia , Esternotomia/efeitos adversos , Idoso , Exsanguinação/etiologia , Ventrículos do Coração/patologia , Humanos , Masculino , Ruptura Espontânea/patologia
10.
Ann Thorac Surg ; 109(2): e107-e108, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31276648

RESUMO

Patients undergoing sternotomy routinely undergo sternal closure with stainless steel wires. Occasionally these wires can fracture, although normally this presents no concern as the broken wire remains fixed and is not problematic. We report a case of a segment of a broken sternal wire that migrated through the pericardium onto the right ventricular. It was removed with a minimally invasive approach with endoscopic assistance.


Assuntos
Fios Ortopédicos/efeitos adversos , Remoção de Dispositivo/métodos , Endoscopia/métodos , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/lesões , Pericárdio/lesões , Idoso , Falha de Equipamento , Feminino , Fluoroscopia , Migração de Corpo Estranho/diagnóstico , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pericárdio/diagnóstico por imagem , Radiografia Torácica , Esternotomia/efeitos adversos
11.
Rev. esp. anestesiol. reanim ; 66(10): 528-532, dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-192106

RESUMO

A pesar de la extendida y frecuente utilización del catéter de arteria pulmonar en nuestro medio para el manejo hemodinámico en pacientes críticos y particularmente en pacientes tras cirugía cardiaca, en la actualidad siguen planteándose dudas sobre la necesidad de su uso. Es preciso valorar el riesgo/beneficio de su colocación y tener en cuenta sus posibles complicaciones, que aun siendo poco frecuentes, pueden llegar a ser potencialmente graves. En este artículo exponemos una complicación muy poco frecuente ocurrida en nuestro centro sobre el uso del catéter de arteria pulmonar de la que no teníamos constancia hasta ahora. Se trata de una perforación del tabique interventricular y de la pared libre del ventrículo izquierdo debido a una acodadura firme del catéter de arteria pulmonar, que no fue sospechada ni diagnosticada salvo por la visión directa del corazón, tras la esternotomía, durante la cirugía cardiaca. La mejora de la seguridad del paciente implica reflexionar sobre el valor de los eventos adversos, de manera que al aumentar la conciencia de la situación y del mecanismo por el que se producen, pueda reducirse la probabilidad de repetición


Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future


Assuntos
Humanos , Feminino , Idoso , Cateterismo de Swan-Ganz/efeitos adversos , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Complicações Intraoperatórias/etiologia , Aneurisma Aórtico/cirurgia , Cateterismo de Swan-Ganz/instrumentação , Ecocardiografia/métodos , Falha de Equipamento , Septos Cardíacos/lesões , Artéria Pulmonar/diagnóstico por imagem
12.
J Cardiothorac Surg ; 14(1): 185, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684992

RESUMO

BACKGROUND: Cardiac radiofrequency ablation is a popular treatment for arrhythmias. However, it does have some complications, some of which are severe, even fatally. And there were limited reports on cardiac internal perforation after radiofrequency catheter ablation (RFCA) that required a surgical repair. CASE PRESENTATION: A 47-year-old male was admitted to our hospital due to chest congestion for 4 months. He received a radiofrequency catheter ablation (RFCA) 9 months prior to admission. On admission, an echocardiogram showed an abnormal perforation between the left ventricle and the left atrium with moderate mitral valve regurgitation. We therefore performed a mitral valve replacement (MVR) and fixed the abnormal atrial-ventricular breakage via median sternotomy. CONCLUSIONS: Cardiac perforation is a severe complication of cardiac RFCA, operators should be extremely cautious to minimize radiofrequency associated perforations. Such a challenging and complex procedure should be deliberately considered by doctors and patients before implementation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Traumatismos Cardíacos/diagnóstico , Ecocardiografia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias
13.
Rev Esp Anestesiol Reanim ; 66(10): 528-532, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31587921

RESUMO

Despite the widespread and frequent use in our setting of pulmonary artery catheters for haemodynamic management in critically ill patients, particularly after heart surgery, some experts continue to question the need for these devices. Clinicians need to weigh up the risks and benefits of pulmonary artery catheters placement and bear in mind the potential complications which, though rare, can be potentially fatal. We present a pulmonary artery catheters-related complication not hitherto described in the literature, involving perforation of the interventricular septum and left ventricular free wall caused by a kink in the pulmonary artery catheters that was not suspected, and only diagnosed by direct vision of the heart after pericardial opening. In the interest of patient safety, we must consider the impact of adverse events; improving our situational awareness and our understanding of the mechanisms behind such events can help reduce the likelihood of repetitions in the future.


Assuntos
Cateterismo de Swan-Ganz/efeitos adversos , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Complicações Intraoperatórias/etiologia , Idoso , Aneurisma Aórtico/cirurgia , Cateterismo de Swan-Ganz/instrumentação , Ecocardiografia/métodos , Falha de Equipamento , Feminino , Septos Cardíacos/lesões , Humanos , Artéria Pulmonar/diagnóstico por imagem
14.
J Med Case Rep ; 13(1): 301, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31543075

RESUMO

BACKGROUND: Primary effusion lymphoma is a rare, high-grade non-Hodgkin's lymphoma that usually occurs in immunosuppressed or human immunodeficiency virus-positive individuals in advanced stages of the disease. However, primary effusion lymphoma occasionally affects immunocompetent patients who are infected with human herpes virus type 8 or Epstein-Barr virus. This disease manifests with liquid collections in cavities, producing constitutional symptoms; fever; weight loss; and symptoms related to extrinsic compression, such as dyspnea or abdominal discomfort. Diagnosis is confirmed with cytological or tissue evaluation showing large, multinucleated lymphoid cells with positive specific markers for the disease, such as CD45 and markers related to viral infections, when present. There is no standard treatment for primary effusion lymphoma, but several chemotherapy protocols are recommended, usually with poor results. CASE PRESENTATION: We present a case of an adult human immunodeficiency virus-negative Hispanic origin woman with primary effusion lymphoma with pleuritic, pericardial, and peritoneal compromise who also had unusual complications during a diagnostic procedure: the accidental rupture of the left ventricle and the development of a secondary left ventricular pseudoaneurysm. We describe the clinical, radiological, and laboratory characteristics as well as the outcome of this case. CONCLUSIONS: Primary effusion lymphoma is a very rare entity that represents 4% of non-Hodgkin's lymphoma cases associated with human immunodeficiency virus and 0.1% to 1% of all lymphomas in patients with another type of immunodeficiency in regions where human herpes virus type 8 is not endemic. This reported case is an unusual presentation of primary effusion lymphoma because it occurred in an immunocompetent human immunodeficiency virus-negative adult woman without the presence of Kaposi's sarcoma or Castleman's disease and for whom the clinical course after chemotherapy was successful. However, the rupture of the free wall of the left ventricle is a very rare catastrophic event that usually occurs after myocardial infarction. Left ventricle free wall rupture rarely goes unnoticed, but when it occurs, it leads to the development of a ventricular pseudoaneurysm in which the rupture is contained by the pericardium with an organized thrombus and an adjacent hematoma.


Assuntos
Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Doença Iatrogênica , Linfoma de Efusão Primária/diagnóstico , Toracoscopia/efeitos adversos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Feminino , Humanos , Imunocompetência , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
Am J Case Rep ; 20: 1155-1158, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31387984

RESUMO

BACKGROUND Ventricular rupture is a complication of acute myocardial infarction (AMI) that results in hemopericardium and cardiac tamponade and has a high mortality rate. Most cases involve the left ventricular free wall, and there have been few previous reports of solitary right ventricular free wall rupture. This report is of a case of fatal right ventricular free wall rupture during percutaneous coronary intervention (PCI) for inferior acute myocardial infarction (AMI). CASE REPORT A 76-year-old woman underwent emergency coronary angiography following inferior AMI. During angiography and attempted percutaneous coronary intervention (PCI), sudden onset of cardiac arrest occurred due to cardiac tamponade. Blood was drained from the pericardium by pericardiocentesis. Despite of advanced cardiac support, the patient died. The post mortem findings showed a solitary right ventricular free wall rupture due to inferior myocardial infarction. CONCLUSIONS A rare case is presented of right ventricular free wall rupture following AMI that occurred during PCI. This case demonstrates that early diagnosis and management are required to prevent patient mortality.


Assuntos
Tamponamento Cardíaco/etiologia , Ruptura Cardíaca Pós-Infarto/etiologia , Ventrículos do Coração/lesões , Infarto Miocárdico de Parede Inferior/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Evolução Fatal , Feminino , Humanos
16.
Elife ; 82019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31393264

RESUMO

Cardiac neural crest cells contribute to important portions of the cardiovascular system including the aorticopulmonary septum and cardiac ganglion. Using replication incompetent avian retroviruses for precise high-resolution lineage analysis, we uncover a previously undescribed neural crest contribution to cardiomyocytes of the ventricles in Gallus gallus, supported by Wnt1-Cre lineage analysis in Mus musculus. To test the intriguing possibility that neural crest cells contribute to heart repair, we examined Danio rerio adult heart regeneration in the neural crest transgenic line, Tg(-4.9sox10:eGFP). Whereas the adult heart has few sox10+ cells in the apex, sox10 and other neural crest regulatory network genes are upregulated in the regenerating myocardium after resection. The results suggest that neural crest cells contribute to many cardiovascular structures including cardiomyocytes across vertebrates and to the regenerating heart of teleost fish. Thus, understanding molecular mechanisms that control the normal development of the neural crest into cardiomyocytes and reactivation of the neural crest program upon regeneration may open potential therapeutic approaches to repair heart damage in amniotes.


Assuntos
Diferenciação Celular , Ventrículos do Coração/lesões , Miócitos Cardíacos/fisiologia , Crista Neural/fisiologia , Regeneração , Animais , Animais Geneticamente Modificados , Galinhas , Camundongos , Peixe-Zebra
17.
Ann Thorac Surg ; 108(6): e405-e407, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31470008

RESUMO

Chest tube thoracostomy is a standard procedure in every intensive care unit. Although it is regarded as a safe procedure in experienced hands, rare complications do occur. This report describes iatrogenic perforation of the left ventricle after placement of an intercostal catheter and the successful surgical management of this injury. Various operative situations that may arise in relation to iatrogenic perforation of the left ventricle are also discussed, as well as steps to manage this potentially life-threatening complication.


Assuntos
Tubos Torácicos/efeitos adversos , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Abscesso Pulmonar/cirurgia , Toracostomia/métodos , Idoso , Seguimentos , Humanos , Doença Iatrogênica , Abscesso Pulmonar/diagnóstico , Masculino , Medição de Risco , Esternotomia/métodos , Resultado do Tratamento
18.
Braz J Cardiovasc Surg ; 34(4): 484-487, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454204

RESUMO

Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.


Assuntos
Ponte de Artéria Coronária , Drenagem/instrumentação , Monitorização Neurofisiológica Intraoperatória/métodos , Mediastino/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Drenagem/métodos , Estudos de Viabilidade , Ventrículos do Coração/lesões , Humanos , Derrame Pericárdico/prevenção & controle
19.
Rev. bras. cir. cardiovasc ; 34(4): 484-487, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1020488

RESUMO

Abstract Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.


Assuntos
Humanos , Complicações Pós-Operatórias/prevenção & controle , Drenagem/instrumentação , Ponte de Artéria Coronária , Monitorização Neurofisiológica Intraoperatória/métodos , Mediastino/cirurgia , Derrame Pericárdico/prevenção & controle , Drenagem/métodos , Estudos de Viabilidade , Ventrículos do Coração/lesões
20.
JACC Clin Electrophysiol ; 5(7): 854-862, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31320015

RESUMO

OBJECTIVES: This study tested the hypothesis that a biphasic defibrillation waveform with an ascending first phase (ASC) causes less myocardial damage by pathology and injury current than a standard biphasic truncated exponential (BTE) waveform in a swine model. BACKGROUND: Although lifesaving, defibrillation shocks have significant iatrogenic effects that reduce their benefit for patient survival. METHODS: An ASC waveform with an 8-ms linear ramp followed by an additional positive 0.5-ms decaying portion with amplitudes of 20 J (ASC 20J) and 25 J (ASC 25J) was used. The control was a 25-J BTE conventional waveform (BTE 25J) RESULTS: The ASC 20J and ASC 25J shocks were both successful in 6 of 6 pigs, but the BTE 25J was successful in only 6 of 14 pigs (p < 0.05). Post-shock ST-segment elevation (injury current) in the right ventricular electrode was significantly greater with BTE 25J than with ASC 20J and ASC 25J. With a blinded pathology reading, hemorrhage, inflammation, thrombi, and necrosis 24 h post-shock were significantly greater with BTE 25J than with ASC 20J and ASC 25J. Troponin levels were also markedly lower at 3, 4, 5, and 6 h post-shock. CONCLUSIONS: Defibrillation shocks cause electrophysiological, histological, and biochemical signs of myocardial damage and necrosis. These signs of damage are markedly less for an ASC waveform than for a conventional BTE waveform.


Assuntos
Desfibriladores , Cardioversão Elétrica , Ventrículos do Coração , Miocárdio/patologia , Animais , Desfibriladores/efeitos adversos , Desfibriladores/normas , Modelos Animais de Doenças , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/métodos , Cardioversão Elétrica/normas , Eletrocardiografia , Eletrodos , Feminino , Ventrículos do Coração/lesões , Ventrículos do Coração/fisiopatologia , Masculino , Necrose/etiologia , Suínos , Troponina C/sangue
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